HIV diagnosis during pregnancy may be a profoundly shocking and life-changing experience for the newly diagnosed HIV-positive woman. There may be a complex mix of emotional, psychosocial, relationship, economic and even legal issues that arise directly out of the HIV diagnosis. The newly diagnosed woman also has

a relatively brief time in which she needs to be able to develop trust in her medical carers and attain sufficient medical knowledge of her situation to be able to make informed decisions that will affect the long-term health of herself, her fetus and her male partner. Prevention of MTCT can only be achieved if the pregnant woman embraces the medical interventions appropriately. To maximize the effectiveness of the interventions for pregnant women in reducing MTCT the psychosocial context of their HIV infection p38 MAPK inhibitor must not be overlooked. Clinical experience indicates that the management of issues including dealing with the diagnosis and uncertainty during pregnancy and robust confidentiality processes have an impact on adherence Topoisomerase inhibitor to ART and acceptance of recommended interventions and all clinicians must be mindful of

this. Studies from around the world have shown significant prevalence of intimate partner violence in pregnancy (14% in the UK to 63% in Zimbabwe), which seems to be greater in women who are HIV positive. NICE antenatal guidelines recommend asking all pregnant women about domestic violence and this would be even more important in women with HIV (especially those with a recent diagnosis or a positive partner) [336–338]. 9.1 Antenatal HIV care should be delivered by a multidisciplinary team (MDT), the precise composition of which will vary. Grading: 1D The minimum team would comprise an HIV specialist, obstetrician, specialist midwife and paediatrician, with the recommendation of peer- and voluntary-sector support. All efforts should be made to involve the woman’s GP and health visitor. It may be necessary to involve some of the following: patient advocates, social workers, legal advocacy, clinical dipyridamole psychologists, psychiatrists, counsellors, health advisors, Citizens Advice Bureau

workers, interpreters, community midwives, clinical nurse specialists and health visitors [339]. In settings with relatively few HIV-positive pregnant women, it is still important to develop robust pathways of care with identified members of an MDT. Regular links, formal or informal, can also be established with a larger unit to provide advice and support as necessary. Good communication is vital in view of the complexity of the issues involved. An early assessment of the social circumstances of a newly diagnosed HIV-positive woman is important. Patients who initially refuse interventions or default from follow-up need to be identified and actively followed-up. Support by trained peer-support workers is a valuable component of the management of HIV-positive pregnant women.